APPLICATION FORM FOR ADMISSION

DISTANCE EDUCATION
ENROLLMENT NO. SESSION
YEAR OF ADMISSION MEDIUM
YEAR OF PROGRAMME
NAME OF COURSE
DURATION FROM To (in case of certificate & diploma course)
Compulsary Subject
ORIGNAL SUBJECT
NAME OF APPLICANT FULL NAME                  MIDDLE NAME           LAST NAME
IN ENGLISH
IN HINDI
MOTHER'S NAME:
IN ENGLISH
IN HINDI
FATHER'S NAME:
IN ENGLISH
IN HINDI
PERMANENT ADDRESS:
Street City/Address Post
District State PIN Code
STD Code Phone Mobile E-Mail
CORRESPONDING ADDRESS:
Street City/Address Post
District State PIN Code
STD Code Phone Mobile E-Mail
SEX
CATEGORY :
DATE OF BIRTH
NATIONALITY
DOMICILE
RESIDENCE
EXAMINATION CENTER(For Distance Education)
AADHAR CARD NO.
EDUCATION QUALIFICATION:
EXAMINATION BOARD/UNIVERSITY YEAR OF PASSING % OF MARKS OR GRADE SUBJECTS
Secondary/ Matriculation
Sr. Sec / Intermediate / 10+2
Under Graduate
PG Graduate
Any Others
Whether employee or dpendent of the employee of JVBI/JVB(if yes, attach certificate)      

DECLARATION BY THE APPLICANT

I DECLARE THAT:
1. I have read the institute prospectus carefully.
2. I shall neither indulge myself or instigate any other student in ragging create nuisance to the academic atmosphere of the institute.
3. The above information is true to the best of my knowledge and belief. In case any information is found wrong at any state, my candidature may be treated as cancelled.
     If, admitted I promise to abide by the rules and regulation of the institute.



DATE:                                                                                                                                                                                                                                                                              (Signature of Applicant)


CERTIFICATES TO BE ATTACHED(With Admission Form):
1. Self attested copies of all marksheets
2. certificate of date of birth
3. Certificate regarding ST/SC/OBC/PH
4. Certificate needed the point no. 16 above
5. Orignal Migration Certificate/Transfer Certificate/Affidavit  (Only for distance education students)


for office use only

Addmission Test Held On Detalied of Fee Deposited
Interview Held On Amount in Rupees:
Recommendation: DD/Receipt No.
Accepted for Admission Issuing Bank
Rejected Due To Dated


Signature of concerned autority


Signature of Accountant


Note: E-version of the Application Form may be downloded and the same should be submitted alongwith prescribed fee in prospectus. All D.Ds. should be in the name of The Registrar, JVBI, Ladnun payable at SBI/ OBC/UCO, ladnun. For complete detail please visit the Institute website at www.jvbi.ac.in.